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HomeMy WebLinkAboutSEP2006-00092 a - Jefferson County Department of Community Development Office Use Only 621 Sheridan St., Port Townsend WA 98368 (360) 379-4450 Date 31 $/b6 Evaluation of an Existing Onsite Sewage System (EES) Fee _3t7=51,7 Recpt 0 / Draw on the back of this sheet a current plot plan showing location of: Check Buildings, Drainfields, Septic Tanks, Wells, etc OR attach a current plot plan I 6, identifying these items. Case , I _ .. ALL SPACES MUST BEIEEtrIN'-- If information is no vailable enter (NV) or pot applicable (NA). TypEvaluatierr - °-- Reason for Evaluation ❑ Routine Operation and Monitoring Inspection tgl Evaluation of on-site sewage system §4 Real Estate transaction El Evaluation of drinking water ❑ Complete a Permit # ❑ Building Permit Review and/or no septic permit on file ❑ Evaluation of on-site sewage&drinking water ❑ Other, explain Date of evaluation n-2,-21{0(0 Inspected by Oafs Wlll!smith (EnYiroc lc, Tax Parcel # (19tSc oGoo t Permitted System yes X no Permit/case # SEP \v Subdivision, Division, Block and Lot(s) u s A001'TteN Og1-14 G, \L-sts 11-03 Lot Size ,08-71"1-4 cre or Dimensions X Current Owner ?-1 ps,y., �Ra F.Lfl Site Address 5I roit, ,N;c. \\ L Rp.) k)oicc- Nkp Owner Phone# --- (co-°t8t-c,S D5 Previous property owner name(s) - (NN if not known) M.L.E LnoLLy , 'Shlkio+3k+1n8A1-t- Directions to Site r- Cf.t', t sc\', Nw/ ,,/ btt NM.1 kat ‘ E\R) Ste,iDALg-EziLls kg N,A so w.c tc k L ?.0,, Date System Installed 1JN1 Age of Dwelling ‘ l O # B lrooms a House Occupied yes x, no, vacant how long? 3 S`-1-- Who installed system? ■j`( Send completed report to: Owner Name ( �0,.. ZRpssFiEL.Q Mailing Address p,c,.gc,)c kL3c1 , Pverr- ,., r o 1g3 ahon_/email/fax 3Coo-9 S.t-oSo5 (, E.Ir r�32LS9lV7 EE-∎3112esdREc ,`t.c Realtor or Other Representative Name RECEIVED Mailing Address Phone/email/fax MAR 28 2006 EE::: _.... ,,_. ... _ -r ,-,,.-. - -, Jefferson County , { Environmental Health r Include the following items on your plot plan: ❑ Property boundaries ' ❑ Wells ❑ Names of adjacent streets ❑ Septic tank ❑ Driveways and parking spaces ❑ Drainfield (enter NN if unknown) ❑ Surface water(ponds,creeks, etc) ❑ North Arrow ❑ Buildings(residence, sheds,garages, etc) PLOT PLAN-date prepared v3 Lo(0 ---R,„„, N L.,: REL P) {___________7-) 1; / i �, 6.905 / C ' ' i'l''':.//,-' -' / ''''''- z7 14,'(" ,---- ,t_19 7 ' '.- • \Ab,..vSE , Q , N al p C,g'WEL DQIvT/ Wctiu; i� / ...,,- -- / % 'D s'rlieCT . NOT TO SCALE RECEIVED ENVIR CHECK, L.L.C. 1612 Hastings Ave.W. Port Townsend, WA 98368 Al-A:IELo(Niv) MAR 28 2006 \,-. JeffersomGcorltY Environmental Health Permit#o Parce # ' CcO\ Evaluation o an Existing Onsite Sewage System_ 7130' 4__pdf page 2 r, i ' Date of Inspection 03W-V)(Q Inspected by Deb (Emfiracheck, LLC) Water Supply (fill in only if water supply is being tested in this evaluation) Sample was taken Yes No Sample Results Well casing 12" above ground Yes No Sanitary Seal in place Yes No Public: offsite onsite Name of System Individual: offsite onsite Is well more than 100' to drainfield/disposal component _yes_ no, not, distance Is well more than 50' to tanks and effluent transport line_yes_ no :v11=1 • , - ,- I- ONSITE SEWAGE SYSTEM #Bedrooms/gallons per day indicated in County Health Dept. records for this case \...SV MAR 28 20tj #1 - Septic Tank Jeffers On Tank size \ xot.0 gal. single compartment )( two compartment C'1- tit Canny Riser to grade on inlet yes x no. Riser to grade on outlet yes k T1�HeaI Condition of tank y_ good needs repair, describe 1st comp.Scum (top layer) p in. sludge(bottom layer) Vg, in. 2nd comp.scum 0 in. sludge 4 in. Was ground water observed leaking into tank? yes no If yes,where was water observed? Condition of baffles: Inlet: X needs repair material (PVC,►oncr- -) Outlet: oo needs repair material .concrete) Screened Outlet )C no yes, condition clean clogged/dirty Septic tank needs to be pumped (per Jefferson County code 8.15.150 (1) (b)))L yes no Effluent level at outlet(mark level on circle) CD If effluent is below the outlet, indicate when tank was last pumped: ( eg: © ) Does system include a pump? yes If yes, complete the next section )C. no(if no slap to section 3) #2 - Pump Chamber Tank size gal. Material. Riser to grade? yes no Condition of tank good needs repair, describe Solids in Tank(see 8.15.150) yes no scum in. sludge in. Was Ground water observed leaking into tank? yes no If yes,where was water observed? Screen around pump? no yes, condition clean dirty/clogged Shroud around pump? no yes Electrical Components Pump operating yes no, describe High water alarm functions yes no, if no, describe Elec. Panel condition good needs repair, describe Pump cycle drawdown inches. Time for pump cycle min/sec. Timer Settings min/sec on min/hrs off Floats secured: yes no Permit#or( ,"h '\\A. ppe..Dp` Evaluation o an Existing Onsite Sewage System 7 r4 ,i4__ , , #3 — Drainfield Appropriate Vegetation in area yes no. Describe vegetation Indications of surfacing sewage (check one) yes , if yes, describe and diagram on plot plan no drainfield area is overgrown and not observable Signs of parking/driving in area yes no X drainfield area unknown Ground settling or erosion yes no overgrown/not observable Monitoring Port Observations(if present): Residual Head yes, #of inches no Ponding in trench yes, #of inches of ponded effluent no Repair area is? Available as shown on permit k None evaluated or shown on permit Addendum (page 5) is attached for evaluation of Treatment Unit or detailed evaluation of drainfield _yes no COMMENTS(attach additional sheet if necessary): #1-A. Risers are mandatory on next inspection. othertA) No permit is on file as to size, location or RECEIVED adequacy and it could not be determined MAR 2 81006 Jefferson County SEE ATTACHED ADDENDUM Environmental Health OTAEa Was a System Problem Identified?Yes X if yes,what section#. (1k) No This report on the existing onsite sewage system is valid for the permitted or historic(if installed prior to permit requirements)use of the system only and does not constitute assurance of future County approvals(such as building permits)on this parcel.Any future application will be judged separately by the rules and laws in effect at that time. I certify that the i formation provided is based on a review of County records and my direct observations at the time of inspection. Name ig ature Date No guarantee of future onsite sewage system performance is implied or granted based on the information contained in this report. This report constitutes a summary of findings only. Permit#o Par 9({'* w(gyp 1 Evaluation of an Existing Onsite Sewage System ,_07,30/(.14__pat" Lace -, p��e( # 944-tecio6i)1 DATE o 3°01L ADDENDUM ADDRESS I Lru Rai 01, OWN E ? Enviro Check,L.L.C. Company Disclaimer Based on what we were able to observe and our experience with on-site wastewater technology,we submit this Sewage treatment Inspection/Evaluation Report based on the present condition of the on-site sewage treatment system.Enviro Check,L.L.C.has not been retained to warrant,guarantee,or certify the proper functioning of the system for any period of time in the present or future.Because of the numerous factors (usage,soil characteristics,previous failures,etc.)which may affect the proper operation of a septic system, as well as the inability of our company to supervise or monitor the use or none visible areas of the system, this report shall not be construed as a warranty by our company that the system will function properly for any particular buyer or owner.Enviro Check,L.L.C.disclaims any warranty,either expressed or implied, arising from the inspection/evaluation of the septic system or this report/evaluation.We are also not ascertaining the impact the system is having on the groundwater or environment. Enviro Check,L.L.C. does not make any claim,warranty or guarantee as to where property lines/boundaries of properties are located.And does not warrant or guarantee any encroachments from on site sewage systems on to adjacent properties.Any indications of possible property lines/boundaries are approximations and do not indicate legal property lines or boundaries. Enviro Check,L.L.C.will not be held responsible in any way for information being undisclosed (intentionally or unintentionally)by property owner,representative or other parties of interest. All reports,including E.E.S.inspection reports are subject to any change by Jefferson County Environmental Health Department.Enviro Check,LLC is not liable for any such changes. All parties are encourages to check county records for any information regarding properties. Company RECEIVED Enviro Check,L.L.C. 1612 Hastings Ave.W MAR 2 8 ZOnb Port Townsend,Wa.98368 360-379-9400 Jefferson CountYth I acknowledge that I have studied the information contained herein and that my assefii IiQ [,'done in accordance with Jefferson County Ordinances,and to the best of my ability,correct. Dale '. TY ij_.smith Co-Manager SAMPLING (Septic tank) MEASUREMENTS Date- Counter Setting- PH Result- Hour Meter- DO Result- Temp.Result-